Te Hauora Roopu
If this is an URGENT matter please make direct contact with someone from the Hauora Team.
Name of ākonga
Year 13 +
Puna ako Kaiako
Are whānau aware of this referral
Is the ākonga aware that you have referred your concern on? (Please inform student of the referral)
What support is required?
Strengths (e.g. social skills, sports or subjects) and protective factors (relationships with specific people, engagement in passions and interests) of ākonga:
What has been attempted prior to this referral by kaiāwhina/kaiako/kaiārahi?
Name of referrer (Your referral will be reviewed at our next Hauora hui on Tuesday and we will make contact following this)
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Haeata Community Campus.